Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 5526 | FL |
NPI | 1063852549 |
---|---|
Provider Name | Jodi Dietz |
First Address | Boca Raton, FL 33428-4778 |
Second Address | Boca Raton, FL 33428-4778 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2013 |
Last Update Date | 28/06/2013 |